The Upper Extremity Lymphatic System Is Not Symmetrical in Individuals: An Anatomic Study Utilizing ICG Lymphography and SPECT/CT Lymphoscintigraphy.

IF 7.5 1区 医学 Q1 SURGERY
James E Fanning, Rosie Friedman, Angela Chen, Valeria Bustos, Mohamed Ismail Aly, Aaron Fleishman, Young Kwon Hong, Leo Tsai, John A Parker, Kevin Donohoe, Dhruv Singhal
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引用次数: 0

Abstract

Objective: We evaluated whether superficial lymphatic anatomy and functional lymph node drainage are symmetric between the right and left upper extremities of healthy female volunteers, and if handedness is associated with symmetry of superficial lymphatic anatomy.

Background: Symmetry of lymphatic anatomy has been assumed historically. This assumption of individual anatomic symmetry is being utilized clinically and in research without validation.

Methods: 36 normal female volunteers underwent bilateral indocyanine green (ICG) lymphography and lymphoscintigraphy of the upper extremities. Eight collecting vessel pathways of each upper extremity were mapped on ICG lymphography. 13 lymph node groups were visualized on lymphoscintigraphy. Symmetry of lymphatic anatomy and functional drainage were established by comparing the right and left extremities of each participant. Hand dominance was assessed by hand grip strength on a hand dynamometer.

Results: Among the 36 participants, 10 (28%) showed symmetry of all eight upper extremity lymphatic pathways with ICG. However, only 1 (3%) participant demonstrated complete symmetry amongst the 13 lymph node groups. Total symmetry of lymphatic channels was observed on ICG in seven (39%) participants with hand dominance and three (17%) participants without hand dominance (X2 = 2.215, P = 0.137).

Conclusion: Lymphatic anatomy and functional drainage of the upper extremities are not consistently symmetric. Functional nodal drainage as demonstrated by lymphoscintigraphy shows less symmetry than anatomic studies of lymphatic channels using ICG. Symmetric lymphatic anatomy does not appear to correlate with hand dominance. These findings challenge the prevailing assumption of left-right lymphatic symmetry.

个体的上肢淋巴系统并不对称:利用ICG淋巴造影和SPECT/CT淋巴管造影的解剖学研究
目的:我们评估了健康女性志愿者左右上肢浅表淋巴解剖和功能性淋巴结引流是否对称:我们评估了健康女性志愿者左右上肢的浅表淋巴解剖和功能性淋巴结引流是否对称,以及手型是否与浅表淋巴解剖的对称性有关:背景:淋巴解剖学的对称性历来被认为是正确的。方法:36 名正常女性志愿者接受了双侧吲哚菁绿(ICG)淋巴造影和上肢淋巴管造影检查。在 ICG 淋巴造影上绘制了每个上肢的 8 条集合血管通路。淋巴管造影显示了 13 个淋巴结群。通过比较每位受试者的左右肢体,确定淋巴解剖和功能引流的对称性。手部优势通过手部测力计的握力进行评估:结果:在 36 名参与者中,有 10 人(28%)通过 ICG 检查发现上肢全部八条淋巴通路均对称。然而,只有 1 名参与者(3%)显示 13 个淋巴结组完全对称。7 名(39%)手部占优势的参与者和 3 名(17%)手部不占优势的参与者在 ICG 上观察到淋巴通道完全对称(X2 = 2.215,P = 0.137):结论:上肢淋巴解剖和功能性引流并非始终对称。淋巴管造影显示的功能性结节引流的对称性低于使用 ICG 进行的淋巴管解剖研究。对称淋巴解剖似乎与手部优势无关。这些发现挑战了左右淋巴对称的普遍假设。
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来源期刊
Annals of surgery
Annals of surgery 医学-外科
CiteScore
14.40
自引率
4.40%
发文量
687
审稿时长
4 months
期刊介绍: The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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